Breast Cancer Research and Treatment

, Volume 140, Issue 1, pp 135–142

Contralateral mastectomy improves survival in women with BRCA1/2-associated breast cancer

  • D. Gareth R. Evans
  • Sarah L. Ingham
  • Andrew Baildam
  • Gary L. Ross
  • Fiona Lalloo
  • Iain Buchan
  • Anthony Howell
Epidemiology

DOI: 10.1007/s10549-013-2583-1

Cite this article as:
Evans, D.G.R., Ingham, S.L., Baildam, A. et al. Breast Cancer Res Treat (2013) 140: 135. doi:10.1007/s10549-013-2583-1

Abstract

BRCA1/2 mutation carriers with breast cancer are at high risk of contralateral disease. Such women often elect to have contralateral risk-reducing mastectomy (CRRM) to reduce the likelihood of recurrence. This study considers whether CRRM improves overall survival. 105 female BRCA1/2 mutation carriers with unilateral breast cancer who underwent CRRM were compared to controls (593 mutation carriers and 105 specifically matched) not undergoing CRRM and diagnosed between 1985 and 2010. Survival was assessed by proportional hazards models, and extended to a matched analysis using stratification by risk-reducing bilateral salpingo-oophorectomy (RRBSO), gene, grade and stage. Median time to CRRM was 1.1 years after the primary diagnosis (range 0.0–13.3). Median follow-up was 9.7 years in the CRRM group and 8.6 in the non-CRRM group. The 10-year overall survival was 89 % in women electing for CRRM (n = 105) compared to 71 % in the non-CRRM group (n = 593); p < 0.001. The survival advantage remained after matching for oophorectomy, gene, grade and stage: HR 0.37 (0.17–0.80, p = 0.008)—CRRM appeared to act independently of RRBSO. CRRM appears to confer a survival advantage. If this finding is confirmed in a larger series it should form part of the counselling procedure at diagnosis of the primary tumour. The indication for CRRM in women who have had RRBSO also requires further research.

Keywords

Breast cancerMastectomyBRCASurvival

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • D. Gareth R. Evans
    • 1
    • 2
    • 3
  • Sarah L. Ingham
    • 1
    • 6
  • Andrew Baildam
    • 3
    • 4
  • Gary L. Ross
    • 5
  • Fiona Lalloo
    • 1
  • Iain Buchan
    • 6
  • Anthony Howell
    • 1
    • 3
  1. 1.Genesis Breast Cancer Prevention CentreUniversity Hospital of South Manchester NHS TrustManchesterUK
  2. 2.Genetic Medicine, Manchester Academic Health Science Centre (MAHSC)Central Manchester Foundation Trust, St. Mary’s Hospital, The University of ManchesterManchesterUK
  3. 3.Manchester Breast Centre, Manchester Cancer Research CentreThe University of ManchesterManchesterUK
  4. 4.Department of Breast SurgeryUniversity Hospital of South Manchester NHS TrustManchesterUK
  5. 5.Department of Plastic SurgeryThe Christie NHS Foundation TrustManchesterUK
  6. 6.Centre for Health Informatics, Institute of Population HealthThe University of ManchesterManchesterUK